'Action potential-like' ST elevation following pseudo-Wellens' electrocardiogram

Area of Science:

• Cardiology
• Internal Medicine
• Clinical Electrocardiography

Background:

• Coronary artery vasospasm is a significant cause of chest pain syndromes, potentially leading to myocardial infarction, arrhythmias, and sudden cardiac death.
• Prinzmetal's angina, characterized by nonexertional chest pain and ST-segment elevation, presents diagnostic and therapeutic challenges, sometimes necessitating interventions like coronary angioplasty.
• Calcium channel blockers are highly effective in managing and preventing coronary artery spasm, providing sustained patient relief.

Observation:

• Wellens' syndrome typically indicates critical proximal left anterior descending stenosis with specific ECG findings (inverted T-waves, preserved R waves).
• Pseudo-Wellens' syndrome, rarely associated with coronary artery spasm, presents a diagnostic mimicry.
• This case details a pseudo-Wellens' syndrome in a patient with vasospastic angina, exhibiting diffuse ST-segment elevation resembling a lambda sign or 'action potential-like' ECG.

Findings:

• The study identifies a rare electrocardiographic manifestation of vasospastic angina, mimicking Wellens' syndrome.
• The observed 'lambda' or 'action potential-like' diffuse ST-segment elevation is linked to coronary artery spasm.
• This presentation underscores the importance of considering vasospasm in atypical ECG findings.

Implications:

• Recognizing this pseudo-Wellens' syndrome presentation is crucial for accurate diagnosis and timely management of vasospastic angina.
• Effective treatment with calcium antagonists can prevent severe cardiac events associated with coronary artery spasm.
• This case contributes to the understanding of diverse ECG presentations of coronary artery vasospasm.